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Testosterone supplementation in men with low T levels appears to have the unfortunate side effect of death.

There is a growing literature on the potential dangers of testosterone supplementation. Not enough yet to say it's as clearly a bad idea as female HRT, but for sure it isn't something men should run out and do without a careful and personalized discussion with a knowledgeable (actual) doctor.

In general I think it's safe to say that the "take extra of the hormones that go down with age in some people" theory of fighting aging is pretty thoroughly discredited by now. Thyroid hormone, growth hormone, testosterone, estrogen, etc. - the science is clear this is not how you fight aging. In general, more likely to hasten death than prevent it.

Off topic, but do you have a link to more info about your dynamometer? IAA biologist interested in measuring mouse activity and exercise capacity. Many people still use those treadmills, which seem less than deal to me (for multiple reasons).

The shortage of doctors in the U.S. is due to the AMA cartel's control over university accreditation and corresponding rent-seeking state laws requiring accreditation. The result is speed-exams when you go visit a doctor (or maybe not see the doctor at all, but rather a "nurse practitioner").

The situation of pilots and doctors does seem similar on several levels, but I think you're drawing the wrong conclusions.

The proximate cause of the "speed-exams" is not a doctor shortage, but an artifact of how most doctors are paid - by the visit. You get a tiny bit more money for a long, complicated visit, but not nearly as much as if you see two or three patients in the same time. This is true for almost every payer - private insurance, Medicare, Medicaid, etc. The financial incentives are strongly on the side of the speed-exam.

A more fundamental question is why the financial incentives matter so much, and that's where I think the pilot and doctor stories have some overlap. These are both highly skilled professions with a long, poorly paid training period and a strong incentive on the part of the "payers" to keep downward pressure on wages. Every time an insurance company or Medicare cuts their provider reimbursement rate, the incentive to cram more visits into a day grows that much stronger, because when you start your career at 30 or 35 with hundreds of thousands of dollars in loans, it's hard to take an arbitrary pay cut. (Talking about primary care doctors here, the situation may be different for the "lucrative" specialist du jour.)

Besides, the US actually has plenty of doctors, similar per capita numbers to Canada or the UK. But the financial incentives drive too many of them to lucrative specialties and urban practices, leaving too few doing primary care or working outside the big cities. Attempting to control costs by cutting doctors' fees creates perverse incentives.

The rise of nurse practitioners is more of an alternative attempt at cost control than a response to too few doctors. If you don't need 8 years of school and training to take blood pressure readings or insert an IV, and these things are actually done better by people who do them all the time, maybe some aspects of primary care can be done better by people with shorter but more focused training.

I work for the government and every once in a while my boss says I should try to patent it.

Do you work for the federal government? Work done by an employee of the federal government in the course of his/her duties is public domain. There's not even a question of patent or copyright, it's public domain by law.

If it's work on your own time that's not part of your official duties, however, you can do whatever you like with it.

My apologies, I meant permissive-with-a-small-p only as an antonym for restrictive. I admit I wasn't aware of the technical meaning. Thank you for pointing it out. I think the phrasing still made sense to most readers. Remember that for most of the physicians who read NEJM this was probably the first time they had even heard of copyleft.

The people who devised the test spent time and money to do so. They created the original work. Why shouldn't they be able to license it for fee to others? They've got college loans to pay off. OH so now educators and researchers have to live under the specter of copyright laws! Boo hoo welcome to the real world!

I am one of the authors of the NEJM article.

We did not get into ethical issues in the article. But much of the current value of the MMSE does not lie in its contents but rather in the past 35 of research on it. Hundreds or thousands of studies from researchers around the world have shown doctors in exquisite detail exactly how and when to use the MMSE to best care for patients.

It is this vast accumulation of data on the validity and utility of the MMSE that makes it so valuable - and little of this was done by the MMSE's authors or PAR. In fact, much of this research might never have been done if the MMSE had had its current strict licensing terms 30 years ago. Some people have compared this behavior - waiting until the test is ubiquitous to start enforcing copyright - to patent trolls.

Nevertheless, the MMSE authors and PAR are entirely within their legal rights, and that is why we suggest that policy needs to change to prevent this from happening all over medicine.

Sorry, I didn't see that the summary incorrectly states that the authors of the older test were claiming infringement. AFAIK, they're not.

I guess I failed the comprehension test. Actually, I didn't really read the summary carefully, since I was already familiar with the actual facts.

I am one of the authors of the NEJM op/ed article.

It is all a little confusing. There are three parties here:1. The original authors of the MMSE, who through PAR are strictly enforcing copyright protections of the MMSE2. The authors of a new tool, the Sweet 16, which was created as an open-access alternative to the MMSE but was "taken down" by PAR in a copyright dispute3. Us, the authors of TFA, who have no relationship to #1 or #2 but are very worried about what this all means for the practice and progress of medicine

I'm not saying the MMSE is useless, it's just no big loss if there is copyright being claimed now. We'll move on to something else.

I'm one of the authors of the NEJM article.

People already are moving on. In our practice we mostly use the Montreal Cognitive Assessment (MOCA) for screening, which is much more sensitive and has liberal licensing terms for non-commercial use.

But this is a general issue. The Sweet 16 was an attempt to move on, halted by PAR. I'm surprised that PAR hasn't already sued the MOCA authors given that the MOCA includes recall and orientation, like the Sweet 16. Even if it survives, the MOCA is not perfect- it has laudably generous licensing terms for copying, but no provision for derivative works. In 80 years, the heirs of the MOCA authors might well start suing researchers who use a trails test, clock draw and animal recognition in a new test.

Whether we move on from the MMSE or not, the threat to scientific progress will remain.

We didn't have the space to describe the MMSE and Sweet 16 in detail, but here's a brief description:

The MMSE has 30 items, which include 10 orientation questions (what's today's date, where are we, etc.) and 6 questions for recall (say 3 standard words, repeat them back and remember them for 5 minutes or so).

The Sweet 16 has 16 items which include 8 orientation questions and 6 questions for recall (using different words than the MMSE). The other two questions involve repeating a sequence of numbers backwards.

So there is a lot of overlap between the two tests, and that was presumably the basis for an infringement claim. However, the items that overlap - orientation and recall - are quite generic and were in wide use long before the MMSE was created in 1975. Nevertheless, the authors behind Sweet 16 and their institution could not or chose not to defend the Sweet 16.

It's a little hard to imagine a cognitive assessment tool that doesn't include orientation or short-term memory recall questions, so this will strongly discourage progress in the field. Perhaps one of the Alzheimer's advocacy groups will take notice and defend researchers trying to advance the state of the art.

The developers of the Sweet 16 - the test apparently "taken down" for copyright infringement of the MMSE - were all Harvard faculty, and work for academic centers that are affiliated with Harvard and its hospitals (Hospital Elder Life Program, Institute for Aging Research and Hebrew Senior Life). The senior author of the Sweet 16 is a well-known Harvard professor. One of the things we find concerning about this case is that Harvard Medical School probably has some claim to ownership of the Sweet 16, and was presumably involved in its defense. If Harvard, with its vast resources, could not or chose not to defend the Sweet 16 successfully, what hope do any other researchers have to develop new cognitive testing tools?

The most abundant chemical used in fracing is water. This is the same water that your waiter serves you with your meal. It's not unusual for frac fluid to be 89% water by mass....If passages are desired, then they are created using hydrochloric acid. This is the same acid that occurs naturally in your stomach.

I triple-dog dare you to drink a glass of 11% (w/w) hydrochloric acid.

It's 89% water and contains only a chemical found in your stomach naturally! That can't possibly hurt you!

These guys aren't fleeing to Seattle because they fear the big-bad regulations of the People's Republic of California. They're fleeing out of fear of Amazon. Amazon's response to the sales tax proposal was to threaten to disown all of its affiliates in California, since the physical presence of affiliates was one of the justifications for asking them to collect sales tax. Amazon would rather stick a knife in the back of all of its partners, putting who knows how many people out of business, than collect a nickel of sales tax from its customers. They can't pull the same thing in Washington because it's hard to deny that giant former hospital on top of a hill with an Amazon logo already constitutes a physical presence.

They left San Francisco because the Bezos bear was gonna swat them out of spite, so they went to cuddle up next to it.

And this "startup" is two guys. Fine, maybe they'll make it big one day, sounds like they got plenty of capital. But it's still two guys. Why does the decision of a two-guy business rate a headline?